CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: North Carolina Baptist Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $64
Cash Discount Price: $98
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at North Carolina Baptist Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.90x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $98 (291%)

Insurance Median: $64 (190%)

Cash: $98 (291% of Medicare)

Ins. Median: $64 (190% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$32 - $171	95%
Apex	$32	95%
Blue Cross Blue Shield	$32 - $68	95%
Cigna	$32 - $187	95%
Devoted	$32	95%
Healthteam	$32	95%
Humana	$32 - $110	95%
Medicare (plans)	$32	95%
UnitedHealthcare	$32 - $69	95%
Wellcare	$32 - $46	95%
Liberty	$37	110%
Medcost	$38 - $134	113%
Amerihealth	$43 - $54	127%
Carolina Complete	$43 - $45	127%
Health Blue	$43 - $45	127%
Partners	$43 - $45	127%
Vaya	$43 - $46	127%
Alliance	$44 - $46	130%
Trillium	$44 - $47	130%
Ambetter / Centene	$51 - $54	151%
Oscar	$57 - $72	169%
Directnet	$112 - $119	332%
Cone Health	$133 - $141	394%
Healthgram	$133 - $141	394%
First Carolina Care	$152 - $161	451%
Private Healthcare Systems	$156 - $165	462%
Multiplan	$171 - $181	507%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $98.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

Insurance In-Network Protection Plan

Contact your insurance company to confirm North Carolina Baptist Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97750.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.